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Dynamic Chiropractic – May 20, 2008, Vol. 26, Issue 11
Dynamic Chiropractic
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Dynamic Chiropractic

Helping Your Patients Combat Recurrent Urinary Tract Infections

By James P. Meschino, DC, MS

After the common cold, the second most common health condition that accounts for visits to doctors' offices are urinary tract infections (UTIs). In fact, 9 million office visits each year involve urinary tract infections.

The common symptoms and signs of UTI include: burning sensation when you urinate; feeling the need to urinate more often than usual; feeling the urge to urinate, but not being able to do so; and cloudy, dark, smelly or bloody urine.

In elderly patients, none of these symptoms may be present. However, if an elderly patient has a fever and/or personality changes with no other symptoms of infection or known cognition problems, a UTI should be investigated (via urine sample).

Women tend to get UTIs more often than men because bacteria can reach the bladder more easily. The urethra is shorter in women than in men; thus, bacteria have a shorter distance to travel. The urethra is also located near the rectum in women. Bacteria from the rectum can easily travel up the urethra and cause infections. For women, sexual intercourse also might cause infections because bacteria can be pushed into the urethra.

There are some basic steps women can take that can help to prevent recurring UTIs. These include the following:

  • Drink more water. Water helps flush the urinary tract and move bacteria out of the body in the urine.
  • Don't "hold it" when you need to urinate. By holding it when you need to go, you enable bacteria that may be present to develop into a full-fledged UTI.
  • Wipe from front to back after a bowel movement. This is especially important to help prevent bacteria from migrating from the anus to the vagina or urethra.
  • Take showers instead of baths. This helps to prevent bacteria from entering the urethra and causing a UTI.
  • Always wash your genital area before and after sexual intercourse. This helps prevent transferring bacteria to the urethra or vaginal area.
  • Wear panties with a cotton crotch. Cotton fabric lets moisture escape, while other fabrics can trap moisture, creating a potential breeding ground for bacteria. Bacteria love moisture.
  • Avoid feminine hygiene sprays and douches. This is especially true for scented douches, which can irritate the urethra and may increase risk of a UTI.
  • Take your vitamin C. Taking 500 mg of vitamin C, twice per day (as found in a high-potency multiple vitamin/mineral) can increase the acidity of your urine. It is more difficult for bacteria to grow in an acidic environment.
  • Take a supplement once or twice per day containing preventive doses of cranberry extract and D-mannose.

Cranberry Extract

Studies demonstrate that cranberry extract contains active constituents that decrease the ability of bacteria to adhere to the walls of the urinary tract. In addition, cranberry extract also helps to acidify the urine, which decreases the ability of bacteria to replicate. The cranberry extract should provide at least 150 mg per capsule and be standardized to contain 30 percent total acids, of which 10 percent are quinic acid and 3 percent are polyphenols. A number of placebo-controlled studies have shown that cranberry extract reduces recurrence of UTIs, even in elderly women.

D-Mannose

As mentioned above, it is best to take a supplement that contains both cranberry extract and D-mannose. D-mannose is a simple sugar the body cannot metabolize (meaning it has no calories and does not affect blood sugar). However, D-mannose acts like a slippery glove around the tentacles of E. coli bacteria, preventing it from clinging to the walls of the urinary tract. In the presence of D-mannose, the bacteria simply lose their grip and slide out of the body each time the patient urinates.

E. coli is the primary culprit in UTIs. It's a stubborn little germ, largely because it grips to the walls of the urinary tract with tentacles that act like little suction cups. Thus, E. coli bacteria are hard to eliminate even with the use of antibiotics, which are sometimes required when a UTI is in progress. However, antibiotics may not kill all the E. coli bacteria. The ones that remain cling to the walls of the urinary tract, giving them a chance to multiply and create a whole new episode in the future. This is where D-mannose comes in. At a daily dosage of 500-1,000 mg per day, it helps to flush E. coli bacteria out of the body before they can stick to the walls of the urinary tract and initiate another infection. Thus, a combination supplement containing cranberry extract and D-mannose, at effective dosages and standardized grade, is a potent one-two punch in the prevention of recurrent UTIs.

If any of your patients suffer from recurrent urinary tract infections, I suggest you provide them with the preceding recommendations and help them find a combination supplement that contains optimal dosages of cranberry extract and D-mannose, which they should take twice daily on an empty stomach.

Resources

  1. American Academy of Family Physicians, 2001-2008. http://familydoctor.org/online/famdocen/ home/women/gen-health/190.html.
  2. NIH Publication No. 04-2097.
  3. Boon H, Smith M. Health Care Professional Training Program in Complementary Medicine. Institute of Applied Complementary Medicine Inc. 1997.
  4. Marles RJ. Review of medicinal plant modules for CCNM. Brandon, Manitoba, Canada: University of Brandon, 1997.
  5. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs, and Cosmetics. 2nd Edition. Toronto/New York: John Wiley and Sons, 1996:649.
  6. Gibson L, Pike L, Kilbourn JP. Effectiveness of cranberry juice in preventing urinary tract infections in long-term care facility patients. Journal of Naturopathic Medicine, 1991;2(1):45-7.
  7. Avorn J, Manone M, Gurwitz JH, et al. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. Journal of the American Medical Association, 1994;271:751-4.
  8. Kilbourne JP. Cranberry juice appears to prevent urinary tract infections. CCML Newsletter, January 1986.
  9. Haverkorn MJ, Mandigers J. Reduction of bacteriuria and pyuria using cranberry juice. Journal of the American Medical Association, 1994;272(8):590.
  10. Katz LM. Reduction of bacteriuria and pyuria using cranberry juice. Journal of the American Medical Association, 1994;272(8):589.
  11. Hamilton-Miller JMT. Reduction of bacteriuria and pyuria using cranberry juice. Journal of the American Medical Association, 1994;272(8):588.
  12. Goodfriend R. Reduction of bacteriuria and pyuria using cranberry juice. Journal of the American Medical Association, 1994;272(8):588.
  13. Hopkins WJ, Heisey DM, Jonier M, Uehling DT. Reduction of bacteriuria and pyuria using cranberry juice. Journal of the American Medical Association, 1994;272(8):588-9.
  14. Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infection. Journal of Urology, 1984;131:1013-6.
  15. Zafriri D, Ofek I, Adar R, et al. Inhibitory activity of cranberry juice on adherence of Type I and Type P fimbriated escherichia coli to eukaryotic cells. Antimicrobial Agents and Chemotherapy, 1989;33(1):92-8.
  16. Brown D. Herbal Prescriptions for Better Health. Rocklin, Calif: Prima Publishing, 1996:349.
  17. Howell AB, Vorse N, Der Maderosian A. Inhibition of the adherence of P-fimbriated Escherichia coli to uroepithelial-all surfaces by proanthocyanidin extracts from cranberries. N Engl J Med, 1998;339:1005-6.
  18. Stothers LA. A Randomized Placebo Controlled Trial to Evaluate Naturopathic Cranberry Products as Prophylaxis Against Urinary Tract Infection in Women. The American Urological Association 2001 Annual Meeting; June 2-7; Anaheim, Calif.
  19. Schaeffer AJ, Chmiel JS, Duncan JL, Falkowski WS. Mannose-sensitive adherence of Escherichia coli to epithelial cells from women with recurrent urinary tract infections. J Urol, May 1984;131(5):906-10.
  20. Mannose-Sensitive Adherence of Escherichia Coli to Epithelial Cells. 81st Annual Meeting of the American Society for Microbiology. Dallas, Texas. March 2-4, 1981.
  21. Michaels EK, Chmiel JS, Plotkin BJ, Schaeffer AJ. Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats. Urology Research, 1983;11(2):97-102.

Click here for more information about James P. Meschino, DC, MS.

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